| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $5K | $13K | 17.04% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $3K | $4K | $7K | 11.14% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $2K | $2K | 4.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $3K | $2K | $5K | 10.78% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $2K | $2K | 4.00% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $3K | $2K | $5K | 15.68% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $1K | $1K | 4.00% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $508 | $212 | $720 | 21.24% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $136 | $136 | 4.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 SELF FUNDED MEDICAL | Claims processing Service code 12 | — | $180K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 539 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 539 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 414 | $78K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 414 | $78K |
| Life insurance | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 539 | $60K |
| Short-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 476 | $45K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 539 | $30K |
| Other | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 539 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 539 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.